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UAR/PROP 65_PRE 2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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18633
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2300 - Underground Storage Tank Program
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PR0501096
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UAR/PROP 65_PRE 2019
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Entry Properties
Last modified
11/20/2024 9:22:03 AM
Creation date
11/4/2018 5:29:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
UAR/PROP 65
FileName_PostFix
PRE 2019
RECORD_ID
PR0501096
PE
2381
FACILITY_ID
FA0004985
FACILITY_NAME
CLEMENTS GARAGE
STREET_NUMBER
18633
Direction
E
STREET_NAME
STATE ROUTE 88
City
CLEMENTS
Zip
95227
APN
01924030
CURRENT_STATUS
02
SITE_LOCATION
18633 E HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\E\HWY 88\18633\PR0501096\UAR_PROP 65.PDF
Tags
EHD - Public
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9D -LL <br /> UNDERGROUND STORAGE TANK UNAUTHORIZED RELEASE (LEAK)/CONTAMINATION SITE REPORT <br /> EMERGENCY HAS STATE OFFICE OF EMEWfiNCY SERVICES FOR LOCAL AGENCY USE ONLY <br /> ❑ YES ENO REPORT BEEN FILED? YES ❑ NO I HEREBY CERTIFY THAT 1 AM A DESIGNATED GOVERNMENT EMPLOYEE AND THAT I HAVE <br /> .REPORTED THIS INFORMATION TO LOCAL OFFICIALS PURSUANT TO SECTION 251807.OF <br /> REPORTDATE CASES THE HEALTH AND SAFTY CODE : r <br /> u u r Y SIGNEDr f..5{`�f-� ,k. - �'I'•.1.•,/f___ F DATE ' <br /> NAME OF INDIVIDUAL FILING REPORT PHONE SIGNATURE --t-- <br /> C ktr/es E Hu (207)W-39V0 ✓�l <br /> �u REPRENTING ❑ OWNER'OPERATOR ❑ REGK)NALBOARD COMPANY OR AGENCY//N+AME �'^ -- <br /> il LOCAL AGENCY ❑ OTHER �EKN /N Cou A G e& Serv:/-IIes <br /> w <br /> � <br /> ADDRESS <br /> � [� c <br /> / /�. N N J EET UC :Pi CITU SPATE ✓2 0 2, Zp <br /> NAMECONTACT PERSON PHONE <br /> adi <br /> - [YJ UNKN WN o b Q67) .�7- 5563 <br /> ADDRESS /peke ,�y.� /�A <br /> U• 8 REE lVI✓( CT 64 STATE 23 p <br /> FACLITY NAME(F APPLICABLE) OPERATOR PHONE <br /> 6 zckwP ervrcz o/ (269,) "/59-7770 <br /> ADD SS <br /> x 1s63s c. Hwy or �a9? <br /> k' STREET CRr , lW COUNTY s'27 <br /> �+ CROSS STREET - <br /> a <br /> a LOCALAGENCY AGENCY NAME CONTACTPERSON PHONE <br /> YN 4 c St 6Ps (boy )0-39,w <br /> W REGKNIAL ARD PHONE <br /> a <br /> y (1) ` /� / NAME QUANTITY LOST(GALLONS) <br /> "(rofeCN'1^ Akpe(•rb:gNS ❑ UNKNOWN <br /> �gyj W <br /> Ica G{ ❑ UNKNOWN <br /> 2 <br /> DATDISCOVERED HOW DISCOVERED ❑ NVENTORY CONTROL ❑ SUBSURFACE MONITORING ❑ NUISANCE CONDITIONS <br /> w I <br /> u u Z- 6 o r 0r E:] TAMC TEST TANK REMOVAL ❑ OTHER <br /> DATE DISCHARGE BEGAN METHOD USED TO STOP DISCHARGE(CHECK ALL THAT APPLY) <br /> M M o o r r geWKNOWN ❑ REMOVECONTENTS ❑ REPLACE TANK dCLOSE TANK <br /> O NASDYES BEEN STOPPED? ❑ REPAIRTANK ❑ REPAIRPIPWG ❑ CHANGEPROCEDURE <br /> o ❑ NO FYES.DATE Ml M 01 0 r Y ❑ OTHER <br /> SOURCE OF DISCHARGE CAUSE(S) <br /> ❑ TANKLEAK ER UNKNOWN ❑ OVERFLL ❑ RUPTURE/FAILURE ❑ SPILL <br /> ❑ PIPING LEAK ❑ OTHER ❑ CORROSION F(!�rUNKNOWN ❑ OTHER <br /> WgWgw CHECKONEONLY <br /> G ❑ UNDETERMINED ❑ SOILONLY ❑ GROUNDWATER ❑ DRINKING WATER (CHECK ONLY F WATER WELLS HAVE ACTUALLY BEEN AFFECTED) <br /> CHECK ONE ONLY <br /> ❑ NOACTX)NTAKEN ❑ PRELMMARY SITE ASSESSMENTWORKPLAN SUBMITTED ❑ POLLUTIONCHARACTERRATION <br /> iq ❑ LEAK BEING CONFIRMED ❑ PRELMWARYSITEASSESSMENTUNDERWAY ❑ POST CLEANUP MONITORING IN PROGRESS <br /> ❑ REMEDIATIONPLAN ❑ CASE CLOSED(CLEANUP COMPLETED OR UNNECESSARY) ❑ CLEANUP UNDERWAY <br /> CHECK APPROPRIATE ACTIONS) ❑ EXCAVATE 6 DISPOSE(ED) ❑ REMOVE FREEPROOUCT(FP) ❑ ENHANCED BIODEGRADATION(IT) <br /> PE[BY:RNYiRTA� <br /> 8 ❑ CAPSITE(CD) ❑ EXCAVATE BTREAT(ET) ❑ T'UMPB TREAT GROUNDWATER(GT) ❑ REPLACE SUPPLY(RS) <br /> ❑ CONTAINMENT BARRIER(CS) ❑ NO ACTON REWIRED INA) ❑ TREATMENT AT HOOKUP(HUI ❑ VENTSOIL(VS) <br /> T❑ VACUUM EXTRACT(VET ❑ OTHER(OT) <br /> tai,.�C fGrrKO Va� , so; P`Y.oesal so;l cd++ YnL eA7-.�rT"�f+er sr�K` ass ess MPn, <br /> cpi11 be lT" fi -Y/e lNqh�rNre a. W erftf <br /> eme �I Co <br /> A?f9V� �s <br /> ps <br /> H ICNPIAM <br />
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